Pine Ridge Hospital Fails Inspection Again

SIOUX FALLS, S.D. —An embattled government-run hospital whose leadership had promised to significantly improve its operation has again been found in violation of quality-of-care standards.

The Indian Health Service, which administers the hospital on South Dakota’s Pine Ridge Indian Reservation, announced December 16 that federal inspectors determined the failures, primarily in the emergency department, constituted an “immediate jeopardy” situation. That’s a term used when a hospital’s actions have caused or are likely to cause serious injury or death to a patient.

Neither the Indian Health Service nor the Centers for Medicare and Medicaid Services, whose representatives conducted the inspection, released a copy of the document detailing the infractions Friday. The Indian Health Service, however, said that it “immediately began instituting improvements” upon learning of the inspection results.

“For instance, Pine Ridge is implementing improvements to its medical provider credentialing and privileging process; improving its quality monitoring in the emergency department and implementing a clinical decision tool so medical providers have access to the most current standards of practice,” the agency, commonly referred to as IHS, said in a statement released Friday evening. The IHS provides free health care to enrolled tribal members as part of the government’s treaty obligations to Native American tribes.

The inspection findings are a setback for the agency and raise questions over the efficacy of some of the changes that the agency promised and implemented throughout 2016, including the privatization of emergency rooms at three hospitals and changes in leadership at a regional office based in South Dakota.

Willie Bear Shield, vice president of the Great Plains Tribal Chairmen’s Health Board, said the contractor selected to run the emergency rooms, including the one on Pine Ridge, faced a November deadline to fully staff the departments.

“This makes us more leery of that (staffing) agency and its ability to provide the quality health care that it was contracted to bring to our people,” Bear Shield said.

The IHS began making changes and got a new leader after unannounced inspections at the hospital in Pine Ridge and the one in the adjacent Rosebud Indian Reservation uncovered serious failures. Inspectors cited the Pine Ridge facility for safety deficiencies, including unsecured drugs and medical records, while an inspection of the Rosebud hospital found conditions so alarming the ER was closed for seven months.

The findings jeopardized the agency’s ability to bill the government for services provided to Medicare- and Medicaid-eligible patients. As a result, the IHS in April entered into what constitute last-chance remediation agreements for each facility with the Centers for Medicare and Medicaid Services.

IHS’s obligations in both agreements include ensuring that an “effective system” is in place to identify “unsafe situations and other barriers to safe, high quality care, adverse events and near misses” and to be able to immediately report those issues to hospital and IHS management.

“I think it’s safe to say that by Pine Ridge getting immediate jeopardy status, the inadequacies of quality health care continue on,” Bear Shield said. “It’s another black eye on them, so to speak. It tells that their yearlong effort to combat these inadequacies is failing.”